Field Reimbursement Manager - Kidney (IN-KY-TN)
Vertex Pharmaceuticals
4 days ago
On-site
Indiana, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education, troubleshooting, and territory-level payer expertise to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Compliantly connect with nephrology office care team/admin staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues and ensure coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial/government prescription insurance coverage requirements, access requirements, and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding and documentation, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand; adapt to office workflows.
- Develop territory engagement plans; adhere to strict non-promotional and compliance/privacy guardrails; maintain patient health information confidentiality; apply program business rules.
Knowledge and Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience.
- Account management with HCPs/office staff; navigate payer portals, CRM/sales tools.
- Strong training/relationship-building, analytical, and data/reporting skills; results-driven; strategic account planning.
- Judgment/problem-solving; travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep benefits investigation/PA/appeals/coverage knowledge; payer knowledge of Medicare, Medicaid, and commercial plans.
Benefits:
- Eligible for annual bonus and annual equity awards.
- Medical, dental, and vision benefits; paid time off (incl. week-long summer and winter shutdown); educational assistance (incl. student loan repayment); commuting subsidy; matching charitable donations; 401(k).
Application:
- Apply per recruiter/hiring manager instructions; for hiring-process accommodations contact ApplicationAssistance@vrtx.com.
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education, troubleshooting, and territory-level payer expertise to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Compliantly connect with nephrology office care team/admin staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues and ensure coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial/government prescription insurance coverage requirements, access requirements, and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding and documentation, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand; adapt to office workflows.
- Develop territory engagement plans; adhere to strict non-promotional and compliance/privacy guardrails; maintain patient health information confidentiality; apply program business rules.
Knowledge and Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience.
- Account management with HCPs/office staff; navigate payer portals, CRM/sales tools.
- Strong training/relationship-building, analytical, and data/reporting skills; results-driven; strategic account planning.
- Judgment/problem-solving; travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep benefits investigation/PA/appeals/coverage knowledge; payer knowledge of Medicare, Medicaid, and commercial plans.
Benefits:
- Eligible for annual bonus and annual equity awards.
- Medical, dental, and vision benefits; paid time off (incl. week-long summer and winter shutdown); educational assistance (incl. student loan repayment); commuting subsidy; matching charitable donations; 401(k).
Application:
- Apply per recruiter/hiring manager instructions; for hiring-process accommodations contact ApplicationAssistance@vrtx.com.